在无症状重症大动脉狭窄症中进行大动脉置换与保守治疗:AVATAR试验
Marko Banovic1,2, Svetozar Putnik1,3, Martin Penicka4
1Belgrade Medical School, University of Belgrade, Serbia (M.B., S.P.).
Circulation
|November 15, 2021
概括
与保守治疗相比,在无症状严重的大动脉狭窄症 (AS) 患者的早期手术大动脉置换 (SAVR) 显著减少了不良事件. 这表明SAVR甚至在症状出现之前可能是有益的.
科学领域:
- 心脏病学
- 心脏外科
- 临床试验
背景情况:
- 在有症状的患者中,严重的大动脉狭窄症 (AS) 是进行大动脉置换手术 (SAVR) 的明确迹象.
- 在无症状的严重AS患者中,SAVR的最佳时间和保存的左心室功能仍在研究中.
研究的目的:
- 评估早期SAVR与无症状严重AS患者的保守治疗的安全性和有效性.
- 确定早期SAVR是否会降低所有原因死亡,心肌梗塞,中风或心力衰竭住院的综合终点.
主要方法:
- 这项AVATAR试验是一项前性,国际性的随机对照试验.
- 157名无症状的严重AS患者和正常的LV功能被随机分配到早期SAVR或保守的治疗.
- 需要进行负面的运动测试,主要终点是主要心血管不良事件的组合.
主要成果:
- 在平均32个月的随访后,对157名患者进行了分析.
- 早期手术组 (n=78) 与保守组 (n=79,26事件) 相比,主要复合终点事件 (13事件) 显著减少 (HR 0.46;P=0.02).
- SAVR的手术死亡率为1. 4%,并没有观察到二次终点的显著差异,尽管趋势有利于早期手术.
结论:
- 与保守治疗相比,在严重AS无症状患者的早期SAVR显著降低了主要心血管不良事件的复合性.
- 这些发现提供了初步支持,无论症状状况如何,在严重的AS中考虑早期SAVR.
- 在ClinicalTrials.gov注册的AVATAR试验 (NCT02436655) 提供了有关AS管理策略的宝贵见解.
更多相关视频
相关概念视频
Aortic Regurgitation III: Medical Management
68
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
68
Mitral Stenosis III: Medical Management
42
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
42
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
76
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
76
Aortic Regurgitation I: Introduction
71
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
71
Aneurysm III: Interprofessional Care
52
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
52


